Permit 11.
CITY TIGARD MECHANICAL PERMIT
A DEVELOPMENT SERVICES PERMIT #: MEC2005-00702
�— 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/19/2005
PARCEL: 2S103BC -02900
SITE ADDRESS: 12180 SW ALBERTA AVE ZONING: R -4.5
SUBDIVISION: CANOGA PARK LOT: 003 JURISDICTION: TIG
Project Description: Install (2) fireplace inserts, and gas line.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 2
Owner: FEES
KELLY, DANIEL D + MELODIE Description Date Amount
12180 SW ALBERTA [MECH] Permit Fee 10/19/20C $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/19/20C $5.80
Phone: 503 - 579 - 5446 Total $78.30
Contractor:
SUBURBAN @ HOME
6014 NE 112TH AVE. REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97220
Phone: 503 257 - 5438
Reg #: LIC 143335
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1 -800- 332 -2344.
/
Issued By:
1 .9
_ ` i/ PermitteeSignature: /i , ,,. /,..,_/ _�� /a
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application, _ . FOR OFFICE USE ONLY
City d E i Tigard 1 Received Q Pit No.¢� 6 L O
13125 SW Hall Blvd., Tigard, OR 97223 DateB l�j 00.) D Permit 1 ► ► ' 7do�
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 9 A7k*Ili � Date/By: Other Permit:
Inspection Line: 503.639.4175 n'�' ( AI Date Ready/By: eMeth S See Pen l for
Internet: www.ci.tigard.or.us Ch�vt Irl� I i, ^ � . Notified/Method: lige Supplemental Information
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�. -,_� . - .� <a� :_ &„ � ,.� ,,� °;,� .. __,..:.� , . __. ,. , ..W�..,,,a, ...... ..... Y. -,,... .eKLISTe
Mechanical permit fees* are based on the value of the work
❑ New construction ddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ D lition /` s ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
,;' :i :':.., e Valu $
;;, w' CATEGORY° OF;� CON `' Ah` «"
: � = ' EQUIPMEIV'T PSYST - § "I ' ' /J
IN._�= a 2-famil Yellin c ` - SCP ., a.,. , « � a .. _ :... ° <..,,: ,...•. ',. a:;¢ ,z_ � _;ax.� : - .,. �;, --
y, g ❑ /industrial 0 building
❑ Multi = family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
N
z ; _. JOB SITE;INFORMA'TI - ANDLO, ATI i , `
,�.•�_ i" Q ON�:-a ; °� .; < Heating/cooling
Job site address\ ` P` ` e: ' Air conditioning or heat pump
(' ,\ •"� v (requires site plan showing placement) 14.00
0
City/State /Z1P Fumace 100,000 BTU (ducts /vents) 14.00
Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street /directions to job site: -- Duct work 14.00
Hydronic hot water system 14.00
-
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: • Other fuel appliances
:i < ;,;,:. a ` >y: Waterh ater 1
' =DES e 0 00
�('�. � CIII'.T?IONr <OF WORK <�
�((���� Gas fireplace 10.00
G.JL1(� e E a ve..) - - r� � Flue vent -for water heater or gas
e s t • . ', IS - ie- _Sj it. fireplace 10.00 ` pO
W �� T `� t . Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
_; g` a„ „
; , ,,• „u R, Chimney/liner /flue /vent 10.00
:R ;� ROPERTY:'O -- -, - :,t, , „ ANT.. ; c .y.. > > <
< m 1 ' Other: 10.00
Name: Environmental exhaust and ventilation
Address` ` ti Range hood/other kitchen
Oil __ '_ • equipment 10.00
City/State /ZII \ f� Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone I . G.L, J0 Fax: ( ) toilet compartments, utility rooms) 6.80
.,,� „� , � ; . ms `;�` =�r�” i ,� :,,:=,�- t:,, _ >::,.:< .:�•�� i / r w s ace fan s 10.00
'" °. =PLIC °ANT ' ;: 'a ..CON Att c c a 1 p
<, _., �-, , ; ":.- ..r.•• � � - -:; , ,: ; «���.'- ::.�,r..; . - <- :_::. =; ,::.., -, ,- ,TACT,PERSON.,., - .- -,_��'
Other: 10.00
Business name }( -of1 ��� \c '(( ) Fuel piping
Contact na $5.40 for first four; $1.00 for each additional
Address: XT A \ S`� \ \ .\. n tC \�'`o Furnace, etc.
`I` Gas heat pump
City/State /Z11 C 4 \Cl" 0 - C� V Wall /suspended /unit heater
Phone: ( 5y6 (3r4 r `- Fax:: 6A. Water heater
E -mail: Fireplace S
Range
«i ena : ,,,ftj 9ONTRAC OR ;11: ' �� - `n Barbecue
5,
Business name: �pt�2{ �(u� Clothes dryer (gas)
' `.� Other:
y
Address. ` '1 L\ X .'" ) \ aNI• ( -' )C J 1 'k' °`=$.. MEGIIANICAI *-,y
z�: � PER11IhT� FEES . �? "` i y ;, 9 <
; -,
= -` 'J`( \ ) C9 e to a8 Subtotal 3s ;AA,
\ h� Minimum permit fee ($72.50)
Phone.'( 3 C- — \5 Jl) Fax:Qx` �d�-A C6--` Plan review (25% of permit fee)
CCB lie.: \ _ 1 ��� r J State surcharge (8% of permit fee) •
TOTAL PERMIT FEE rte.)
Author signat • � This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print na 1„,_.,1t'J ay , _ Date: rtni * Fee methodology set by Tri- County Building Industry Service Board
, nnn A411,11i innirnnenvnni
CITY OF TIGARD _
BUILDING DIVISION PERMIT #: MEC2005.00702
13125 SW Hall,Blvd., Tigard, OR 97223 DATE ISSUED: 10119/2005
Phone: (503)'639 - 4171 ■■ ,,Wpulpu��l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: /112/2005 TIME: 7:04AM PAGE: 54
SITE ADDRESS: 12180 SW ALBERTA AVE CLASS OF WORK:
SUBDIVISION: CANOGA PARK LOT #: 003 TYPE OF USE:
PROJECT NAME: KELLY
DESCRIPTION: Install (2) fireplace inserts, and gas line.
OWNER: KELLY, DANIEL D + MELODIE, PHONE #: 503- 579 -6446
CONTRACTOR: SUBURBAN (is?, HOME PHONE #: 503 -257 -5438
Inspection Request Scheduled For: Date: 11/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 020111-01 503 -257 -5438 N
Corrections /Comments /Instructions: p
7� 4- 57e) 77 e--a d
/ e ag/ e IO& / ,ter 4-
. .r_cur ed 1/(a O
G
7 .._ __,,,
10 PASS I PARTIAL APPROVAL (l CANCEL n NO ACCESS
FAIL ni A LL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: ; V I Date: 2.- ". J
" v Phone #: (503) 718-